Hemorrhoids

What are hemorrhoids?

You might be surprised to learn that hemorrhoids are a normal part of our anatomy. We have internal and external hemorrhoids, located inside the anal canal and around the anal opening, respectively. Internal hemorrhoids are part of the vascular network supplying blood to the anus and consist of small arterial branches. External hemorrhoids are veins.

We don’t pay attention to our hemorrhoids when they are in their normal state. They do not cause any symptoms. Sometimes, problems can arise from internal hemorrhoids, known as “internal hemorrhoid disease.” Such symptoms may occur occasionally or can be chronic (long-lasting).

External hemorrhoids cause symptoms when a blood clot suddenly forms in one of the veins at the anal opening, known as “thrombosed external hemorrhoid.” This blood clot results in a lump that can cause anal pain and, sometimes, bleeding between bowel movements.

Problems with both internal and external hemorrhoids are common.

What are the symptoms of internal hemorrhoid disease?

Symptoms of internal hemorrhoid disease include:

• Bleeding from the anus, usually bright red, during and occasionally between bowel movements
• Anal pain, especially during or after bowel movements
• Anal itching or burning
• Difficulty cleaning the anal area
• Swelling (prolapse) of internal hemorrhoids during bowel movements. Hemorrhoids may retract on their own or may need to be pushed back into the anus by hand.
• Foul-smelling discharge

Factors that can lead to hemorrhoid problems include:

• Straining during bowel movements
• Hard or watery bowel movements
• Spending long periods on the toilet (for example, reading or playing video games)
• Low-fiber diet
• Pregnancy
• Aging

How is hemorrhoid disease diagnosed?

Diagnosis of hemorrhoid disease begins with a visit to your doctor. The doctor will ask about your symptoms and perform a physical examination of the anal area.

During an anal examination, the doctor will:

• Inspect the skin around the anus.
• Perform a digital examination, where a lubricated gloved finger is gently inserted into the anus.
• Examine the inside of the anal canal—where the internal hemorrhoids are located—with a lighted tube called an anoscope.

In some cases, a more extensive examination, such as a colonoscopy, may be needed to ensure that your symptoms are not due to any other disease in your colon or rectum.

How is internal hemorrhoid disease treated?

Various treatments are available for internal hemorrhoid disease. Not all patients will need endoscopic or surgical intervention.

For milder or occasional symptoms, the following interventions may help:

Keep the stools soft by increasing the amount of fiber in your diet to 30 grams/day and, if needed, starting a fiber supplement.

Develop good toilet habits, such as not straining or sitting on the toilet for long periods. If you are constipated, a stool softener or laxative may be added after consulting with your doctor.

Take warm baths to relieve intense pain from bowel movements.

For more severe or chronic symptoms, other options are available. The best choice for you depends on the size of the internal hemorrhoids and how severe your symptoms are.

Techniques for treating internal hemorrhoid disease include:

Rubber band ligation: Usually performed in the office without anesthesia, where rubber bands are placed at the base of the internal hemorrhoids, cutting off blood supply and allowing them to fall off.

Sclerotherapy: Usually performed in the office without anesthesia, where a sclerosing agent is injected into the internal hemorrhoid to create scar tissue.

Doppler-guided hemorrhoidal artery ligation: This surgical procedure is done in an operating room under general anesthesia, using a special device to identify and ligate the blood vessels leading to the internal hemorrhoids, causing them to shrink.

Stapled hemorrhoidopexy: Also performed in the operating room using a specialized stapling device.

Hemorrhoidectomy: The internal and possibly external hemorrhoids are removed by cutting them out.

Infrared coagulation: Coagulation of the veins supplying the hemorrhoids can be done as an outpatient procedure in the office.

In most cases, a thrombosed external hemorrhoid does not require surgery. As the blood clot dissolves, the thrombosed external hemorrhoid shrinks. If necessary, the clot can be removed, or the thrombosed external hemorrhoid can be completely excised. This minor procedure can usually be done in the office.

How can I prevent internal hemorrhoid disease?

Here are some ways to prevent internal hemorrhoid disease:

• Try to keep stools soft. Ensure you consume enough fiber in your diet, about 30 grams/day, by eating fruits, vegetables, and whole grains. A fiber supplement may help you reach your fiber goal. Your doctor may recommend a stool softener or laxatives.
• Exercise regularly to help prevent constipation.
• Develop good toilet habits. Don’t strain or spend too much time sitting on the toilet.
• Don’t delay bowel movements. Go to the bathroom when you feel the urge.

Related Posts